Treatment Of Cervical Facet Dislocations Research Articles

Anterior cervical plating combined with zero-profile anchored spacer for the treatment of cervical facet dislocation in elderly patients

ObjectiveThe purpose of this study was to evaluate the efficacy of anterior cervical plating combined with zero-profile (Z-P) anchored spacer for the treatment of cervical facet dislocation in elderly patients. MethodsThis is a retrospective study. Twelve elderly patients (from 57 to 77 years old, averaged 65 years) with unilateral or bilateral facet dislocation of sub-axial cervical spine from September 2015 to September 2019 surgically treated at the authors’ hospital were enrolled in this study. The patients with osteoporosis or osteopenia were all surgically treated by anterior-only procedure using cervical plating combined with zero-profile anchored spacer after closed manual reduction under general anesthesia and spinal cord monitoring. The operation times (OT), estimated blood loss (EBL), perioperative complications, were recorded. The clinical evaluation included visual analogue scales (VAS) and the American Spinal Injury Association (ASIA) scale. The radiographic evaluation included kyphotic angle (KA) and disc height (DH) and the fusion rate. ResultsAnterior discectomy, interbody fusion and fixation were performed in all patients after the disloctions were reduced by manual maneuver. The average OT was 66 minutes, with a range from 45 to 110 minutes. The EBL averaged 42 ml per surgical procedure, with a range from 20 to 60 ml. The VAS, ASIA, KA were improved significantly after surgery (P<0.05). The average follow-up time was 24.2 months, with a range from 12 to 38 months. There were no statistical differences between the immediately post-op KA and KA at the last follow-up (P>0.05). No disc space subsidence was observed statistically (P<0.05) Interbody fusion was obtained in all patients. Two patient experienced slight difficulty in swallowing, which were improved 6 weeks later. There were no hardware failure, no segmental instability, no wound infection or other complications. ConclusionsManual reduction with spinal cord monitoring under general anesthesia is a safe and efficient option and the anterior cervical plating combined with Z-P spacer could achieve reliable fixation for the patients with cervical facet dislocation in the elderly patients with osteoporosis or osteopenia.

A Novel Anterior-Only Surgical Approach for Reduction and Fixation of Cervical Facet Dislocation

The anterior-only surgical procedure, including discectomy, open reduction, fusion, and fixation, is a recommended approach in the treatment of cervical facet dislocations. This approach has a reduction failure rate of up to 40%. When it fails, a posterior approach is usually required. To report a novel anterior-only surgical approach for reduction and fixation in patients with cervical facet dislocation, even for severe vertebral fracture, articular process fracture, and delayed surgical management. Sixty-three consecutive patients with unilateral/bilateral facet dislocation of the subaxial cervical spine were treated with this anterior-only procedure. After discectomy, kyphotic paramedian distraction reduction with Caspar pins plus vertebral screw plate fixation was performed. If the reduction failed, anterior facetectomy reduction plus anterior cervical pedicle screw plate fixation was introduced. Among the 63 patients treated, 52 patients achieved successful reduction with the technique of kyphotic paramedian distraction with Caspar pins; the remaining 11 patients with failure of the former technique experienced successful reduction with the anterior facetectomy technique. No supplemental posterior approach surgery was performed. The American Spinal Injury Association grade was improved by at least 1 grade in 23 patients after this procedure, and no neurologic deterioration occurred in any of the patients. After at least 12 months of follow-up, all patients achieved satisfactory fusion, and there was no implant failure. An anterior-only surgical procedure including kyphotic paramedian distraction with Caspar pins, anterior facetectomy, and anterior pedicle screw plate fixation is safe and effective for subaxial cervical facet dislocations.

Anterior Facetectomy for Reduction of Cervical Facet Dislocation.

Technique report and case series. The aim of this study was to develop a new surgical technique for anterior reduction in management of unilateral/bilateral facet dislocations and to report the results of 8 patients with successful outcomes associated with this approach. The anterior-only surgical procedure, including discectomy, open reduction, fusion, and fixation, is a recommended approach in the treatment of cervical facet dislocations. This approach is with a failure rate of up to 40%. When it fails, a posterior approach is usually required. We have developed a new surgical approach with facetectomy for anterior reduction of cervical facet dislocations. This technique is especially useful for delayed management of unilateral/bilateral facet dislocation patients who failed the conventional anterior open reduction to avoid a posterior procedure. Eight patients with cervical facet dislocations who failed in the conventional anterior reduction were surgically treated by the anterior facetectomy reduction technique. After discectomy, anteromedial foraminotomy was performed by resection of posterior foraminal part or total of uncovertebral joint. After the nerve root was retracted cephalad in the neuroforamina, the edge of the dislocated superior facet was broken to achieve reduction. Postoperatively, all patients have obtained successful reduction and satisfactory anatomic sagittal alignment. There were no complications attributable to the use of this technique. Anterior facetectomy reduction represents a safe and efficacious but technically challenging option for the treatment of cervical facet dislocation. 5.

Anterior pedicle screw and plate fixation for cervical facet dislocation: case series and technical note

Background ContextThe anterior-only surgical procedure is used as a recommended approach in the treatment of cervical facet dislocations, but an anterior cervical spine implant that offers higher three-column instabilities for stronger fixation is lacking. PurposeThis study aimed to report a new surgical technique of anterior pedicle screw (APS) fixation for cervical facet dislocations and the results of 12 patients with successful application and described safety. Study DesignThe study design includes case series and technical report. Patient SampleThe sample comprises 12 patients with cervical facet dislocations. Outcome MeasuresAnalyses of plain lateral neutral and oblique radiographs and computed tomography scans were conducted to assess reduction, fusion, and the accuracy of pedicle screw placement. Spinal cord compression and decompression was defined by a 1.5-Tesla magnetic resonance imaging. Neurologic status was evaluated according to classification of American Spinal Injury Association (ASIA). MethodsTwelve patients with cervical facet dislocations were surgically treated by the anterior cervical pedicle screw and plate fixation. In these 12 patients (9 male and 3 females), the distribution of spine level was from C3–C4 to C6–C7; the etiologic diagnosis included four unilateral and eight bilateral facet dislocations; the neurologic status comprised four patients with ASIA A, two with ASIA B, two with ASIA D, and four with ASIA E. After discectomy, reduction, and insertion of a peek cage containing autologous bone graft, the APS was inserted along the pedicle axis with the fluoroscope-assisted view imaging. ResultsPostoperatively, all patients had obtained successful reduction and satisfactory anatomic sagittal alignment. There was no complication or instrument failure owing to the use of this technique. Four ASIA A and one ASIA B patients showed no neurologic improvement; one ASIA B patient was improved neurologically to ASIA C; two patients with ASIA D were improved neurologically to ASIA E; no ASIA E patients showed neurologic deterioration. ConclusionsAnterior pedicle screw and plate fixation represents a safe and efficacious but technically challenging option for the treatment of cervical facet dislocations.

A New Anterior-Posterior Surgical Approach for the Treatment of Cervical Facet Dislocations

The preliminary results from a new anterior-posterior surgical approach are reported. To report a novel surgical approach, which was successfully applied to treat 8 cervical facet dislocation patients. The combined anterior-posterior surgical procedure is used as a common approach in the treatment of cervical facet dislocations. However, some problems may arise during the application of this approach, and as a result, surgeons must change the initial surgical plan to anterior-posterior-anterior approach. Between December 2011 and June 2012, 8 patients had facet dislocations were surgically treated by the new anterior-posterior approach. After anterior discectomy, a peek frame cage containing autologous iliac bone particles or tricalcium phosphate bone substitute was inserted in the interspace and fixed with a peek composite buttress plate screwed into the inferior vertebral body. Then, the anterior wound was closed and the patient was turned prone. Through a posterior midline approach, the posterior elements were exposed and the reduction was gradually achieved by posteriorly translating the superior segment and progressively positioning the patient's neck into extension. Then lateral mass or pedicle screws and titanium rods were placed in a favorable and satisfactory position, which was demonstrated by the intraoperative plain radiographs. A posterolateral fusion was performed and the posterior wound was closed. With the use of this new approach, all the patients had obtained successful reduction and satisfactory anatomic sagittal alignment. No instances of neurological deterioration and instrument failure occurred, no complications were owing to the use of this technique, and 4 patients existed neurological functional recovery at the most recent follow-up visit. This reported surgical approach is an efficient and safe way for the treatment of traumatic cervical facet dislocations.

Cervical Facet Dislocations. Outcome of Reduction &amp; Anterior Plating in a Series of 21 Patients

Background Data: treatment of cervical facet dislocations has varied from closed reduction and external immobilization to combined anterior and posterior instrumentation and fusion. Purpose: to evaluate single level anterior fixation for the management of cervical facet dislocations following closed or open reduction. Study Design: retrospective analysis of a case series. Patients and Methods: twenty-one patients (12 unilateral and 9 bilateral) with cervical facet dislocation were treated by reduction and anterior plate fixation. Results: the male to female ratio was 3.2:1. The mean age was 44 years. The commonest affected level was C5-6 (48.2%). Closed reduction by traction and open reduction were successful in 81.2% and 88.8% of attempted trials respectively. Radicular and incomplete spinal cord injuries showed better outcome than complete lesions. Solid fusion in good alignment was achieved in 20 patients while solid fusion with partial re-dislocation occurred in one patient with no further treatment required. Conclusion: anterior plate fixation alone is effective in treatment of cervical facet dislocations which can be successfully reduced either by traction or open anteriorreduction. (2012ESJ029)

Variations in Surgical Treatment of Cervical Facet Dislocations

Retrospective Survey Analysis. To explore surgeon preference in the choice of surgical approach in the treatment of traumatic cervical facet dislocations. The choice of surgical approach in the treatment of traumatic cervical dislocations is highly variable and maybe influenced by a variety of factors. The purpose of this study was to examine inter-rater reliability in choice of surgical approach. Twenty-five members of the Spine Trauma Study Group evaluated 10 cases of traumatic cervical dislocations. Evaluation of the case as a unilateral or bilateral injury and surgeon interpretation of the presence of a disc herniation as well as preferred surgical approach were assessed. Only slight agreement was observed among surgeons in the choice of surgical approach (Kappa < 0.1). This improved slightly when patients were assumed to have a complete spinal cord injury (Kappa = 0.15). Surgeons used more anterior approaches either alone or as the first stage in a combined approach when a disc herniation was present regardless of neurologic status of the patient. When a patient was neurologically intact, an anterior approach was more common than a posterior approach even when a disc herniation was not present. Combined approaches were preferred for the treatment of bilateral facet dislocations. The poor agreement on the treatment of these injuries likely reflects a combination of factors including surgeon training and experience. Treatment decisions are likely to be affected by the neurologic status of the patient, interpretation of a disc herniation, and the classification of the injury as a unilateral or bilateral injury.

Minimally invasive lateral mass screws in the treatment of cervical facet dislocations: technical note.

The technique of lateral mass screw and rod or plate fixation is a major advancement in the posterior instrumentation of the cervical spine. This technique provides rigid three-dimensional fixation, restores the dorsal tension band, and provides highly effective stabilization in patients with many types of traumatic injuries. Patient 1 was a 32-year-old man who had been in a motor vehicle accident. He presented with right C5 radiculopathy. X-ray findings included 45% anterolisthesis of C4 on C5, bilateral facet disruption, and right unilateral C4-C5 facet fracture and dislocation. The patient was placed in Gardner-Wells tongs, and the fracture was reduced with 25 pounds of traction. Patient 2 was a 56-year-old woman who had been in a motor vehicle accident that resulted in complete quadriplegia. Her initial imaging studies revealed a C3-C4 right unilateral facet fracture with subluxation. She was placed in traction, and her neurological status was reassessed. The findings of her neurological examination revealed improvement: she was found to have Brown-Séquard syndrome. Patient 3 was a 33-year-old man who was involved in a diving accident that resulted in bilaterally jumped facets at C3-C4. The patient was neurologically intact, and attempts at closed reduction were not successful. Patients 1 and 2 underwent anterior cervical discectomy with iliac crest autograft fusion and plating. They were then placed in the prone position, and a dilator tubular retractor system was used to access the facet joint at the level of interest. The facet joints were then denuded and packed with autograft. Lateral mass screws were then placed by means of the Magerl technique, and a rod was used to connect the top-loading screws. Patient 3 underwent posterior surgery that included only removal of the superior facet, intraoperative reduction, and bilateral lateral mass screw and rod placement. This technical note describes the successful placement of lateral mass screw and rod constructs with the use of a minimally invasive approach by means of a tubular dilator retractor system. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine.

Cervical facet dislocation: when is magnetic resonance imaging indicated?

Hart, Robert A. MD; Vaccaro, Alexander R. MD; Nachwalter, Richard S. MDEditor(s): McLain, Robert F. MD, Associate Editor Spine Controversies Author Information